Non-Narcotic Analgesics (NSAID’s) 93nia, leucopenia, renal and hepatic damage
and encephalopathy.
PENICILLAMINE
The exact mechanisms of action of peni-
cillamine in rheumatoid arthritis is not
known. After oral administration it is partly
metabolised and partly excreted unchanged.
Adverse effects include Gl upset, dose
related impairment of taste, thrombocytope-
nia, aplastic anemia, allergic reactions, skin
rash, fever, SLE and proteinuria.
SULFASALAZINE
When taken orally, it liberates 5-ASA (5-
aminosalicylic acid) and sulfapyridine in
colon. 5-ASA acts locally by inhibiting PG
synthesis and provide symptomatic relief in
ulcerative colitis. Sulfapyridine is absorbed
systemically and inhibits generation of su-
peroxide radicals and cytokine elaboration
by inflammatory cells and is responsible for
beneficial effects in RA.
METHOTREXATE
It is a dihydrofolate reductase inhibitor
immuno-suppressant. Benefit in RA is due
to inhibition of cytokine production, chemo-
taxis and cell mediated immune reaction.
DRUGS FOR GOUTGout results from hyperuricemia i.e. in-
creased serum uric acid levels. Normal se-
rum uric acid level is 1-5 mg/dl. Uric acid
is formed in the metabolism of purine. When
the blood levels of uric acid are high, it pre-
cipitates in joints, cartilage, kidney and sub-
cutaneous tissues and leads to various signs
and symptoms. Hyperuricemia is also
seen in various leukemias, lymphomas
(increased production) or is drug induced
(due to reduced renal excretion by uric acid).
Drugs used for gout can be divided into
two groups:
a. Drugs for acute attack of gout: NSAIDs,
colchicine, corticosteroids.
b. Drugs for chronic gout/hyperuricemia:
Can be uric acid synthesis inhibitors
(allopurinol) and uricosurics (increase
renal excretion of uric acids) e.g.
probenecid and sulfinpyrazone.
NSAIDS
Drugs useful are indomethacin,
piroxicam or naproxen. Their usefulness is
due to strong antiinflammatory action and
can be continued for 3-4 weeks. They also
inhibit chemotactic migration of leukocytes
into the affected joint.CORTICOSTEROIDS
Systemic/intraarticular steroids can be
used in those cases not responding to or tol-
erating NSAIDs/colchicine.COLCHICINE
It is effective for treatment of acute at-
tacks of gout. It has no effect on renal excre-
tion of uric acid. It binds to tubulin, it in-
terferes with function of mitotic spindles,
causes depolymerization and disappear-
ance of fibrillar microtubules in granulo-
cytes. In gout, the useful of colchicine is due
to the inhibition of the release of glycopro-
teins from granulocytes in inflamed joint
thus preventing precipitation of uric acid
crystals and release of lysosomal enzymes.
After oral administration it is rapidly
absorbed. A major part of the drug is ex-
creted in faeces.